F1000 medicine reports最新文献

Despite the availability of powerful antibiotics, community-acquired pneumonia (CAP) remains one of the leading reasons for morbidity and mortality worldwide, and despite the availability of powerful antibiotics, there has been only little improvement in case fatality rates for many years. Consequently, it cannot be expected that novel antibiotics will substantially improve outcomes in CAP. Therefore, this review focuses on novel approaches that may reduce CAP-related mortality: the impact of immunomodulation by macrolides and fluoroquinolones and the prevention of CAP by pneumococcal vaccines.

Acute myeloid leukemia (AML) is a disorder with significant molecular and clinical heterogeneity. Although there have been clear advances in the identification of somatic genetic and epigenetic alterations present in the malignant cells of patients with AML, translating this knowledge into an integrated view with an impact on the clinical treatment of AML has been slower to evolve. Recent clinical advances in the treatment of AML include studies demonstrating the benefit of dose-intense daunorubicin therapy in induction chemotherapy for patients of any age. We also review use of the DNA methyltransferase inhibitor azacitidine for treatment of AML in elderly patients as well as a study of global patterns of DNA methylation in patients with AML. Lastly, we review a recent assessment of the role of allogeneic hematopoietic stem cell transplantation in AML in first complete remission.

The purpose of this brief article is to review old concepts of the significance of acute symptomatic seizures, the impact of psychiatric comorbidities on the response of pharmacologic and surgical treatments of the seizure disorder, and the importance of factoring comorbid medical comorbidities into the choice of antiepileptic drugs (AEDs). In addition, this article provides an update on the latest data on the teratogenic effects of AEDs and reviews the most relevant results of a recent practice guideline on pregnancy issues in women with epilepsy. The article closes with a review of the latest advances in the therapeutic effects of first- and second-generation AEDs.

Treatment of functional gastrointestinal disorders remains difficult with many very different approaches showing similar response rates, regardless of whether they target luminal contents (e.g., presumed bacterial overgrowth), signaling within the gut wall (e.g., serotonin agonists or antagonists) or processing in the brain (e.g., cognitive behavioral therapy). Discrepancies between recent clinical trials and a meta-analysis have forced us to re-examine the use of antidepressants. Other studies have looked beyond the traditional drug therapies and have suggested other options such as dietary interventions and communication strategies that address relevant disease mechanisms and enable us to understand patient concerns, with the ultimate goal being to individualize and thus improve treatment outcomes.

Computer-delivered cognitive behavioural therapy (CCBT) is emerging as a promising strategy for improving access to mental health services. Randomized controlled trials have confirmed the efficacy of guided CCBT in treating depression, generalized anxiety disorder, panic disorder, social phobia, and other common mental disorders. With proper guidance, effect sizes are comparable to those obtained in face-to-face cognitive behavioural therapy, treatment is cost-effective, and preliminary data indicate that CCBT is acceptable to patients. Trials are beginning to evaluate optimal strategies for integrating CCBT within existing systems of mental health care.

Recent studies investigating the pharmacological management of neuropathic pain support the efficacy of certain antidepressants, anticonvulsants, and opioids. Novel directions in drug applications include topical applications of patches with either lidocaine or capsaicin and intradermal injections of botulinum toxin. In cases of partial pain relief, drug combinations may be considered.

Radical cystectomy with pelvic lymphadenectomy is the standard treatment for muscle-invasive bladder cancer. However, the high recurrence rates and high death rate from metastases after radical cystectomy for locally advanced bladder cancer emphasize the high risk of occult distant disease. To improve patient survival, multimodal therapy whereby chemotherapy and surgery are used in concert with each other is necessary. The preponderance of data suggests that neoadjuvant chemotherapy offers patients a clear - albeit small - survival advantage, whereas the data for adjuvant chemotherapy are less convincing. Currently, trials to improve the results of such neoadjuvant therapy using biologic targets in conjunction with cytotoxic regimens are under way.

γδ T lymphocytes are a numerically small subset of T cells with potent cytotoxic activity against a variety of tumor cells. Human γδ T cells expressing the Vγ9Vδ2 T cell antigen receptor recognize endogenous pyrophosphate molecules that are overproduced in transformed cells. Moreover, the intracellular accumulation of such pyrophosphates is strongly enhanced by aminobisphosphonates used in the treatment of osteoporosis and bone metastasis in certain cancer patients. A new concept of cancer immunotherapy is based on the endogenous activation of γδ T cells with aminobisphosphonates plus low-dose interleukin-2.

The treatment of bipolar depression is one of the most challenging fields in contemporary psychiatry. The best data concern the antipsychotics quetiapine and the olanzapine-fluoxetine combination. However, the usefulness of antidepressants in bipolar depression remains controversial; positive data are available for fluoxetine but negative results have been published for paroxetine. Accumulated knowledge so far suggests that bipolar patients need continuous administration of an antimanic agent even during the acute depressive phase. Although our knowledge is indeed limited, the development of guidelines for polypharmacy is necessary and should be done as soon as possible.

Overwhelming evidence from observational epidemiological studies indicates that herpes simplex virus type 2 (HSV-2) infection enhances the risk of acquiring HIV infection. Studies of genital shedding of HIV have suggested that HSV-2 infection also increases the onward transmission of HIV-1 by HIV/HSV-2 co-infected patients. Several randomized controlled trials were initiated to assess the impact of HSV-2 suppressive therapy on the acquisition of HIV infection by HSV-2 infected men and women, and on the onward transmission of HIV by HSV-2/HIV co-infected men and women. In the past 2 years the results of these trials have been published. HSV-2 suppressive therapy was not found to have any effect on HIV acquisition nor on onward transmission of HIV. However, suppressive therapy with acyclovir was found to slow down disease progression in HIV/HSV-2 co-infected patients. The effect was rather modest and cost-effectiveness studies are needed to assess whether HSV-2 suppressive therapy has a place in the management of HIV-1 infected patients, especially in low and middle income countries.